renal function

Chelation Therapy for Patients with Elevated Body Lead Burden and Progressive Renal Insufficiency: A Randomized, Controlled Trial

Ja-Liang Lin, MD; Huei-Huang Ho, MD; and Chun-Chen Yu, MD

Background: Nephropathy is known to occur in persons exposed to high levels of lead, but the question of whether long-term exposure to low levels of environmental lead is associated with impaired renal function remains controversial.

Objective: To examine whether chelation therapy slows the progression of renal insufficiency in patients with mildly elevated body lead burden.

Design: Randomized, controlled trial.

Setting: Academic medical center in Taiwan.

Patients: 32 patients with chronic renal insufficiency (serum creatinine level > 132.6 µmol/L [1.5 mg/dL] and < 353.8 µmol/L [4.0 mg/dL]), mildly elevated body lead burden (>0.72 µmol [150 µg] of lead per 72-hour urine collection and < 2.90 µmol [600 µg] of lead per 72-hour urine collection [EDTA mobilization tests]), and no history of heavy lead exposure.

Intervention: The treatment group received 2 months of chelation therapy; the control group received no therapy.

Measurements: The reciprocal of serum creatinine (1/Cr) was used as an index of progressive renal insufficiency.

Results: Rates of progression of renal insufficiency were similar in the treatment group and the control group during a 12-month baseline observation period (1/Cr, 0.000054 L/µmol per month compared with 0.000046 L/µmol per month; P > 0.2). After the 2-month treatment period, improvement in renal function was greater in the treatment group than in the control group. In the 12 months after the treatment period, renal insufficiency progressed more slowly in the treatment group than in the control group (1/Cr, 0.000033 ± 0.kidney-beans-1558781-640x96000038 L/µmol per month compared with 0.000045 ± 0.000038 L/µmol per month; P = 0.0030).

Conclusion: Chelation therapy seems to slow the progression of renal insufficiency in patients with mildly elevated body lead burden. This implies that long-term exposure to low levels of environmental lead may be associated with impaired renal function in patients with chronic renal disease.

 

Full Content Available for Subscribers: http://annals.org/article.aspx?articleid=712437

Disappearance of immune deposits with EDTA chelation therapy in a case of IgA nephropathy

by Lin JL, Lim PS

Abstract

In this report, we describe the development of renal function impairment in a 33-year-old patient with mesangial IgA nephropathy and a history of recent gout. Increased body lead burden was identified with a positive EDTA mobilization test. The patient was treated with 1 g of edetate disodium calcium weekly for 2 months until normalization of urinary lead excretion. Improvement of renal function and proteinuria were noted. It was even more interesting to find that both immunofluorescence and electron microscopy studies of the second bioarteriography-1562063-640x600psy specimen revealed the loss of previous mesangial immune deposits. Our case demonstrated that lead may be a nonspecifically damaging factor related to the deterioration of renal function in patients with preexisting renal disease. Moreover, the disappearance of mesangial immune deposits after chelation therapy has not been previously documented. The pathogenetic basis of this observation is unknown, and its causal relationship with lead requires further elucidation.

http://www.ncbi.nlm.nih.gov/pubmed/1292346